Observation
There are some cases where it is imperative to remove the silicone oil promptly. However, in most patients there is no urgency. Surgery may therefore be delayed until a time that is convenient for the patient and physician.
Step 1 – Learn the basics about the eye and silicone oil
Step 2 – Learn about the surgery and what to expect
Step 3 – Learn about the other options
Step 4 – Learn about the potential risks of the procedure
Step 5 – Learn to maximize your results
The eye can be thought of as similar to a camera, with two main parts, a lens and a film. In addition, there is a gel called the vitreous that is located in front of the retina and is very firmly adherent to it. The film layer is called the retina and lines the back wall of the eye.
Patients frequently undergo retina surgery due to the development of a retinal detachment or as a result of scar tissue from diabetes. Both of these conditions may result in full thickness holes in the retina. These holes must be welded down with laser therapy so they do not reopen, causing a retinal detachment. Laser typically takes around 2 weeks to have its maximum effect.
Silicone oil is placed in the eye to prevent the fluid from within the eye from re-entering the retinal tears and getting underneath the retina while the laser is taking effect. Many retinal surgeons will consider removal of the silicone oil after approximately 3 months, since that time frame allows the laser to have its maximum effect.
Silicone oil removal is performed with an outpatient surgical procedure called a pars plana vitrectomy. It may be performed under under twilight (monitored anesthesia care) or general anesthesia.
The retina specialist places 3 small ports that are less than 1 mm in size through the white of the eye and into the vitreous cavity. The silicone oil is removed by infusing the eye with fluid while draining the oil through a small port. The eye is then filled up with air, and then with fluid several times to remove the maximum amount of silicone oil.The surgeon then carefully evaluates the eye to confirm there are no retinal tears. An eye patch and eye shield are placed on the eye. Most patients have very mild discomfort following the surgery, which responds well to over the counter Tylenol.
There are some cases where it is imperative to remove the silicone oil promptly. However, in most patients there is no urgency. Surgery may therefore be delayed until a time that is convenient for the patient and physician.
Some patients may choose not to remove silicone oil due to limited visual potential or the fear of retinal re-detachment. This is an acceptable options for patients who do not have any urgent problems with silicone oil such as high eye pressure or damage to the cornea.
The retina specialists who recommends the treatment will discuss the risks, benefits, and alternatives to the procedure. It is up to the judgement of the physician to weigh the benefit of the procedure to the potential risks. It is only once the decision is made that the benefits outweigh the potential risks is the procedure offered to the patient.
Pars plana vitrectomy with silicone oil removal typically results in a visual improvement. The level of improvement depends on the underlying health of the retina and eye.
The most significant risk of pars plana vitrectomy with silicone oil removal is retinal detachment. Additional risks include the developments of cataract and and infection.
Symptoms of retinal detachment include the sudden onset of many new floaters, new onset flashing lights, or noting a progressive decrease in the peripheral vision (like a curtain coming down at a play). This is urgent and the treating physician should be made aware the same day.
There is a small risk of infection following the procedure. If this is going to occur, it typically occurs 3-5 days following the procedure. Symptoms include redness around the eye that gets worse not better, extreme light sensitivity, and worsening pain. This is a medical emergency and requires immediate treatment by a retina specialist.
Patients who still have their nature lens will experience progression of their cataract following vitrectomy surgery. Approximately 90% of patients who are 50 years or older will require cataract surgery within 2 years.
All surgeries are associated with a number of other uncommon, but possible problems. Potential complications of pars plana vitrectomy include high eye pressure, bleeding within the eye, development of new retinal tears, and the need for further procedures.
It is important to use eye drops as prescribed by your retina specialist. Patients should ask if they need to continue to use prescription eye drops they were using prior to surgery(such as for glaucoma).
Peripheral vision – The peripheral vision should gradually become clearer. If the peripheral vision becomes dark and starts to become larger, this is a sign of a retinal detachment.
The vision is typically very blurry the day following surgery. The vision thereafter will continue to improve
Infection – The eye should continue feeling better following surgery. Infection is characterized by a combination of severe eye pain, profound light sensitivity, and a decrease in vision. This must be treated emergently.
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